Deviation in the Standard of Nursing Care During Administration of Blood Transfusions

Evaluate breaches in the standard of care when evaluating a Deviation in the Standard of Nursing Care During Administration of Blood Transfusions

Answer the following questions to find out if the standard of care was followed for your case.

Was an informed consent obtained prior to the blood transfusion?YesNoAnswer unknownWhy is this important?Prior to the administration of any blood product, an informed consent signed by the patient or a qualified representative of the patient is required, except in the cases of trauma or life saving situations.(2006) 20 ETRMDR 3 218-229

Were the indications for blood transfusion documented in the patient’s record? Why is this important?Answer this question At the time of ordering, the physician needs to verify that the indications for the transfusion are clearly documented in the patient's medical record. (2006) 20 ETRMDR 3 218-229

Was the clinician who administered the blood transfusion, qualified and registered? Why is this important?Answer this question Safe transfusion practice is a complex, multi-step process. Only those qualified staff members possessing a current license to practice nursing as well as the training required by the healthcare facility, may administer a blood transfusion. (2007) 7 ENURED 4 215-227

Was the facility’s policy and procedure for the pre-transfusion blood sampling followed? Why is this important?Answer this question The nursing staff should follow hospital procedures for the collection of pre-transfusion samples and strictly adhere to all steps in the process. (1997) 66 EAORNJ 1 133-136,138,140-143

Did the blood sample used to type and cross match the patient contain accurate information? Why is this important?Answer this question A laboratory technologist needs to use the pre-transfusion blood sample to identify the ABO and Rh blood type of the patient whose name is on the blood sample label. If the pre-transfusion blood sample label is incomplete, incorrect or illegible, the potential for error is high. (1997) 66 EAORNJ 1 133-136,138,140-143

Did the clinician perform and document the final patient identity check at the time of administration? Why is this important?Answer this question Proper identification of the patient from sample collection through to blood administration, proper labeling of samples and products is essential. (2006) 20 ETRMDR 3 218-229

Were incorrect blood components administered to the patient? Why is this important?Answer this question Pre-transfusion verification is the last critical stage of patient identification with blood transfusions. The primary reason for ABO- or Rh-incompatible transfusions is the administration of properly labeled blood to the wrong patient. (2007) 7 ENURED 4 228-237

Did the clinician ensure that the blood transfusion was completed within 4 hours? Why is this important?Answer this question If a blood transfusion cannot be completed within four hours, those blood products must be discarded due to the possibility of bacterial growth in the blood products. (1997) 66 EAORNJ 1 133-136,138,140-143

Did the clinician obtain and record the vital signs of the patient prior to the transfusion? Why is this important?Answer this question After consents are signed and the blood is checked by the appropriate personnel, the nurse should take a complete set of vital signs for a baseline before starting the transfusion. (2006) 20 ETRMDR 3 218-229

Were the vital signs of the patient obtained and documented 15 min after the initiation of blood transfusion, at one hour intervals throughout the transfusion and 30 minutes post transfusion? Why is this important?Answer this question The patient’s vital signs need to be checked 15 minutes after starting the transfusion and then every hour during the blood transfusion according to hospital protocol, in order to check for a reaction to the blood. (2006) 20 ETRMDR 3 218-229

Which of the following adverse reactions did the patient experience? Why is this important?Answer this question Acute transfusion reactions present as adverse signs or symptoms during or within 24 hours of a blood transfusion. The most frequent reactions are fever, chills, pruritus, or urticaria, which may resolve without specific treatment or complications. (2006) 20 ETRMDR 3 218-229

Which of the following symptoms were recognized and documented? Why is this important?Answer this question For severe reactions, initiating immediate treatment is required to prevent the most serious sequelae, including death. Immediate nursing management comprises ceasing the transfusion and notifying the treating physician and the hospital blood bank. These patients usually require ICU support. (2010) 22 ECCNCN 2 179

Which of the following corrective measures were initiated to alleviate the symptoms of the adverse reaction? Why is this important?Answer this question Immediate nursing management comprises stopping the transfusion, re-performing the pre-transfusion checklist, documenting observations, providing immediate patient care and contacting the treating physician. (2006) 20 ETRMDR 3 218-229

Did the clinician document the details of the blood transfusion? Why is this important?Answer this question Adequate documentation of the transfusion is essential. The patient's medical record must include the order for the transfusion, the blood component type issued, the donor unit number, the date and time of the transfusion, pre- and post transfusion vital signs, the amount of blood infused and the identification of the transfusionist. The patient must be observed during and after the transfusion for any adverse effects of the transfusion and the immediate outcome of the transfusion must be documented. (2006) 20 ETRMDR 3 218-229